Assuntos
Adenoma/diagnóstico , Hipopituitarismo/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Adenoma/complicações , Adenoma/patologia , Adulto , Humanos , Hipopituitarismo/etiologia , Hipopituitarismo/patologia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Tomografia Computadorizada por Raios X , Carga TumoralRESUMO
Osteogenesis imperfecta (OI) is a generalised connective tissue disorder associated with low bone mass, bone fragility and increased susceptibility to fractures. First-line treatment to improve bone mineral density (BMD) is usually with bisphosphonates but long-term usage has been associated with uncommon complications such as atypical femoral fractures (AFF). Treatment with teriparatide in this situation has been reported with positive outcomes. However, choice of treatment after 2 years of teriparatide has not been well studied or reported. We describe a patient with OI treated with bisphosphonates for 9 years, who then suffered a spontaneous AFF, was subsequently started on teriparatide for 2 years followed by 6 monthly Denosumab. 1 year post-treatment with Denosumab, there was significant improvement in BMD, good fracture healing and no new fractures. This case highlights the potential use of denosumab following 2 years of teriparatide treatment in patients with OI with AFF.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Fraturas do Fêmur/tratamento farmacológico , Fraturas Espontâneas/tratamento farmacológico , Osteogênese Imperfeita/tratamento farmacológico , Densidade Óssea/fisiologia , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/uso terapêutico , Difosfonatos/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Fraturas Espontâneas/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese Imperfeita/fisiopatologia , Teriparatida/uso terapêutico , Resultado do Tratamento , Raios XAssuntos
Adenoma/complicações , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Hipersecreção Hipofisária de ACTH/etiologia , Neoplasias Hipofisárias/complicações , Inibidores de 14-alfa Desmetilase/administração & dosagem , Inibidores de 14-alfa Desmetilase/uso terapêutico , Adenoma/diagnóstico , Cabergolina , Síndrome de Cushing/tratamento farmacológico , Síndrome de Cushing/etiologia , Agonistas de Dopamina/uso terapêutico , Ergolinas/uso terapêutico , Feminino , Humanos , Cetoconazol/administração & dosagem , Cetoconazol/uso terapêutico , Pessoa de Meia-Idade , Hipersecreção Hipofisária de ACTH/diagnóstico por imagem , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Neoplasias Hipofisárias/diagnósticoRESUMO
Hashimoto's thyroiditis (HT) is a frequently encountered condition in clinical practice and management is generally uncomplicated with patients on a stable dose of thyroxine supplementation. However, complications of thyroid lymphoma can develop, though it is rare and hence commonly forgotten by physicians. We present a case of a patient with HT who developed thyroid lymphoma. A 61-year-old woman presented with an enlarged goitre complicated by compressive symptoms and was diagnosed with HT. She was treated with stable dose of thyroxine but her constitutional symptoms of weight loss prompted further investigations and diagnosis of diffuse large B-cell lymphoma was eventually made. She underwent chemotherapy and adjuvant radiotherapy and is currently in remission 1â year post-treatment. There should be an increased index of suspicion of primary thyroid lymphoma in patients with HT for early diagnosis and treatment for better outcomes.
Assuntos
Doença de Hashimoto/complicações , Linfoma Difuso de Grandes Células B/etiologia , Neoplasias da Glândula Tireoide/etiologia , Terapia Combinada , Diagnóstico por Imagem , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/terapia , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/terapiaRESUMO
Low-dose adefovir therapy has been increasingly recognised as a cause of Fanconi syndrome. Being relatively novel, early diagnosis is both fraught with difficulty and yet of paramount importance given its far-reaching consequences, many of which are amenable to treatment. We discuss a patient who presented with hypokalemia and other electrolyte abnormalities suggestive of Fanconi syndrome whilst on adefovir for hepatitis B. A trans-tubular potassium gradient (TTKG = 9.4) and urinary fractional phosphate excretion (39.4 %) consistent with renal potassium and phosphate wasting together with euglycemic glycosuria, aminoaciduria and hypophosphatemic osteomalacia supported the diagnosis of adefovir-induced Fanconi syndrome. With the cessation of the culprit drug, the patient has achieved partial recovery after 9 months. A high index of suspicion coupled with regular symptom surveillance and electrolyte monitoring is recommended in the course of adefovir therapy.
RESUMO
OBJECTIVE: To present a case of pituitary apoplexy secondary to thrombocytopenia associated with dengue hemorrhagic fever (DHF). METHODS: In this case study, we review the presentation, evaluation, diagnosis, and management of a case of pituitary apoplexy in the setting of DHF. We also searched the literature for cases of pituitary apoplexy associated with thrombocytopenia and review their clinical presentation, management, and outcome. RESULTS: A 53-year-old man presented with fever, lethargy, and worsening headache. Routine investigations revealed thrombocytopenia secondary to dengue fever. He developed symptoms of a cavernous sinus lesion the next day. Urgent magnetic resonance imaging revealed pituitary apoplexy in a pituitary macroadenoma. A transsphenoidal surgery was done and histology was consistent with apoplexy in a prolactin/follicle-stimulating hormone macroadenoma. Subsequently, the patient developed permanent deficits of anterior pituitary hormones. We review 8 other cases of pituitary apoplexy associated with thrombocytopenia reported in the literature. CONCLUSION: Thrombocytopenia due to various causes may be a predisposing factor for pituitary apoplexy in a patient with underlying pituitary disease. In view of the tendency for bleeding associated with thrombocytopenia, the risks of surgical intervention have to be carefully weighed against the potential benefits. Indications for surgery would include progressive alteration of consciousness, visual disturbances, and opthalmoplegia despite conservative management. Patients with underlying pituitary macroadenomas with optic chiasm compression have a worse prognosis, and the chances of recovery, even with early surgery, are limited.